Enlarged Spleen

Overview

The spleen is an organ that serves as part of the lymphatic system, and is located on the left side of the abdomen near the stomach. The spleen performs several important functions inside the body, including filtering the blood, storing blood cells, destroying old blood cells that have reached the end of their useful life and making lymphocytes, which are a type of white blood cell that helps the body fight off infection.

An enlarged spleen, also known as “splenomegaly [spleh·now·meh·guh·lee],” occurs when the spleen has become enlarged by size and/or weight. The size and weight of a healthy spleen can vary from person to person, but a normal adult spleen usually measures up to 12 centimeters (about 4.75 inches) and weighs between 70-200 grams.

A spleen that measures between 12-20 centimeters and weighs between 400-500 grams is considered enlarged. A spleen that weighs more than 1,000 grams is considered to have severe enlargement, known as “massive splenomegaly.” In certain cases, the spleen can grow so large that it ruptures, which can result in life-threatening internal bleeding.

Types of Splenomegaly

There are many different factors that can cause an enlarged spleen, and the different types are classified by the reason for the enlargement. These include:

• Congestive splenomegaly, which is caused by blood pooling in the spleen. It’s often due to a serious condition called portal hypertension, which is usually caused by cirrhosis of the liver. Read more about portal hypertension care at Hoag.
• Infiltrative splenomegaly, which is caused by foreign cells that have invaded the spleen.
  Immune splenomegaly, which is caused by an increase in your body’s immunologic activity and cell replication inside the spleen. This can be due to several factors, including rheumatoid arthritis, sarcoidosis and endocarditis
• Neoplastic splenomegaly, which is when cancerous cells have developed inside the spleen

Having an enlarged spleen is considered rare, with only about 2% of people in the U.S. having the condition. It is much more common in other parts of the world however, including Asia and Africa.

Why Hoag for Treatment of an Enlarged Spleen in Orange County?

Diagnosed with an enlarged spleen? It could be a simple fix, or something serious. And you need a team with the tools, experience and technology to tell the difference fast.

When you need answers you and your family can depend on, The Hoag Digestive Health Institute is here. Hoag has the most comprehensive and highest-volume digestive health program in Orange County, offering pinpoint-accurate diagnosis and the area’s best and most advanced treatment options

Don’t worry and wonder. Know for sure, with Hoag.

Symptoms and Causes of an Enlarged Spleen

An enlarged spleen usually causes no symptoms, and is often discovered during a routine physical exam. There are, however, some symptoms which may suggest you have an enlarged spleen. These may include:

Common Symptoms:

• Abdominal discomfort
• Pain in the upper-left abdomen
• Pain in the left shoulder
• A swelling in the abdomen that can be felt through the skin
• Feeling bloated, or having a distended abdomen
• Unexplained weakness
• Losing weight without trying
• Night sweats
• Anemia, which may cause you to bruising or bleeding easily
• Feeling full after only eating a little
• Feeling faint
• Fever
• A general sense of tiredness or fatigue
• Feeling very chilled, which may include shivering

Potential Causes

There are several factors that can potentially cause an enlarged spleen. These include:

• Liver disease due to factors like cirrhosis or hepatitis
• Cancers of the blood, including lymphomas, leukemias and myeloproliferative disorders
• Focal lesions, which include hemangiomas, abscesses and cysts
• Congestion of the spleen due to issues like portal hypertension, venous thrombosis and congestive heart failure.
• Splenic sequestration, which is a complication of sickle cell disease that usually affects young children
• Acute or chronic infection, including bacterial endocarditis, HIV, tuberculosis, abscess, malaria and other diseases
• Certain connective-tissue diseases, including lupus, rheumatoid arthritis and Still’s disease
• Infiltrative disorders of the body, including sarcoidosis, amyloidosis and glycogen storage diseases.
• Cytopenia, which is a condition in which the body has a lower-than-normal amount of blood cells. This can be due to a number of factors, including immune thrombocytopenic purpura, autoimmune hemolytic anemia, immune-mediated neutropenia and Felty syndrome

Diagnosis and Tests

If you visit a physician with symptoms that suggest you might have an enlarged spleen, your doctor will likely talk to you about what you’re experiencing, followed by a thorough physical exam. Depending on how much your spleen is enlarged, it can potentially be felt by the doctor through the skin.

Depending on the outcome of a physical exam, you may be asked to take other medical tests to confirm an enlarged spleen and try to pinpoint why your spleen is enlarged. These tests may include:

• Abdominal ultrasound, which uses sound waves to create images of the structures inside the body
• Computerized tomography (CT) scans
• Magnetic Resonance Imaging (MRI)
• Blood tests, which may be helpful in discovering why your spleen is enlarged
• Bone marrow analysis, in which a sample of your bone marrow is taken so that it can be examined in a lab.

Advanced Imaging and Diagnosis of Abdominal Conditions at Hoag

The causes of an enlarged spleen can range from a bacterial infection all the way up to serious and potentially life-threatening conditions like cancer. That makes accurate diagnosis particularly important in guiding your treatment options.

At the Hoag Digestive Health Institute, we’re committed to employing next-generation imaging technologies to help patients find the correct diagnosis and treatment path fast. At Hoag, advanced imaging technologies used to diagnosis conditions of the abdomen include:

• FibroScan^®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring and cirrhosis without the side effects and complications of a needle biopsy. Learn more about FibroScan^®
• Hepatobiliary Iminodiacetic Acid (HIDA) Scan, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnosis issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used for quantifying fat deposits in the liver in real time
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder, liver, bile ducts, pancreas and pancreatic duct for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues.
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease.
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for an Enlarged Spleen

Treatment of an enlarged spleen often involves treating the disease that caused the enlargement or managing the symptoms and complications that may come with splenomegaly — including the threat of “splenic rupture,” in which the spleen becomes so big it bursts.

Enlargement due to different causes is treated in different ways. For example, splenomegaly due to splenic sequestration due to sickle cell anemia is usually treated with blood transfusions, while cancers involving the spleen may be treated through chemotherapy and radiation therapy.

Another common treatment for an enlarged spleen is splenectomy, in which the spleen is surgically removed. Because of the role the spleen plays in our immune system, those who undergo splenectomy may be at increased risk of contracting certain bacterial and viral infections.

Prevention

Ways to reduce your risk of developing an enlarged spleen may include:

• Take steps to avoid chronic liver disease, including using alcohol in moderation, and seek treatment for alcohol abuse
• Eat a healthy, balanced diet that’s low in fat, and maintain a healthy weight
• Get regular checkups, including blood work, that can suggest changes in the way your body is functioning
• Take steps to manage chronic conditions that can impact the function of your liver and/or spleen, including Type 2 diabetes, high blood pressure, hepatitis A and B, rheumatoid arthritis, sarcoidosis, etc.